Provider Demographics
NPI:1962387639
Name:VILLACORTA, ARIANA EDNA
Entity type:Individual
Prefix:
First Name:ARIANA
Middle Name:EDNA
Last Name:VILLACORTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17816 N 56TH LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1201
Mailing Address - Country:US
Mailing Address - Phone:703-859-1602
Mailing Address - Fax:
Practice Address - Street 1:17816 N 56TH LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1201
Practice Address - Country:US
Practice Address - Phone:703-859-1602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001308931163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice